A headache simply means a pain or discomfort felt in the head region -whether it is the face, back of the head (occiput), forehead, scalp, behind the eyes etc. A headache can also be caused by referral from the upper neck or even teeth and sinuses. It can also be present even though there is no actual organic cause for it (e.g. depression).

Grouping Headaches

There are numerous causes of a headache, and they can be grouped in various ways. The commonest causes of headache, both acute or chronic, include:

Of course the above will vary with the age of the patient. Children are more likely to suffer from respiratory infections, while older people of glaucoma, temporal arteritis, malignancies etc. Acute causes, such as subarachnoid haemorrhage, meningitis, and epidural and subdural haematomas (after trauma) can occur suddenly (especially subarachnoid haemorrhage) and require immediate management, but will not cause repeated episodes. On the other hand, headache due to other causes, e.g. tension headache, migraine, depression, cervical dysfunction will often recur and may lead to a chronic or recurrent headache. In addition, the chronic use of analgesics by patients may lead to a drug rebound headache (where the headache recurs when they discontinue the medications) which can also complicate matters.

The History of the Headache

The history is often sufficient to obtain an accurate diagnosis – it is especially useful in ruling out serious diagnoses, or making decision on judicious use of investigations (eg. CT). Firstly, questions about the headache itself – when it started, where it is felt, severity, character, associated features (vomiting, visual symptoms), precipitants etc. The following questions are important to rule out a serious diagnosis:

Headache associated with vomiting in the morning or if worse with coughing may indicate raised intra-cranial pressure;

Any visual blurring – glaucoma, benign intracranial hypertension;

Any new headache in an elderly patient could be serious – malignancy, temporal arteritis, depression.

In addition – enquiries should be made of the patient’s lifestyle, stress levels (for tension headache) as well as whether there is any family history of migraines.

Investigations

CT scan head: A CT of the head will help exclude a space-occupying lesion like a tumour or abscess in the chronic setting, and in the acute setting will help with diagnosing sub-arachnoid haemorrhage, subdural haematoma, and infections.

Cervical spine x-ray: The diagnosis of cervical dysfunction is usually clinical, though x-rays can help to diagnose any obvious malalignment or osteoarthritis.

Simple analgesics, general measures, avoidance of precipitants, and specific medications and preventative medications for migraine.

Physical rehabilitation for cervicogenic headache.

Headache Australia is the only Australian charity that aims to support the more than 5 million Australians affected by headache and migraine. Headache Australia is an initiative of the Brain Foundation – a national charity raising funds for research from community donations.